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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005984
Report Date: 08/12/2026
Date Signed: 08/12/2026 02:59:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2026 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20260720170601
FACILITY NAME:CIELO VISTA SENIOR LIVINGFACILITY NUMBER:
306005984
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:7571 WYOMING STTELEPHONE:
(562) 569-8914
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:122CENSUS: 36DATE:
08/12/2026
UNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Virgilio Agas "Gil"TIME COMPLETED:
03:20 PM
ALLEGATION(S):
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9
Staff did not properly transport resident resulting in injury.
Staff did not seek medical attention for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegations. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Gil Agas and discussed the purpose of the visit.

The investigation into the facility allegations mentioned above revealed the following: it was alleged that the facility did not use a hoyer lift properly to transfer Resident #1(R1) and staff did not seek medical attention for R1 after a fall while using the hoyer lift. R1 was admitted to the facility on July 13, 2026. LPA reviewed a preplacement appraisal for R1stating that R1 is non-ambulatory, unable to walk, needs assistance with all activities of daily living and wears diapers. It also states that R1 needs assistance when transferring in and out of bed. This document was signed by facility staff on July 13, 2026. LPA reviewed a needs and services plan for R1 stating that R1 needs assistance on all ADL’s except feeding themselves with facility staff being the person responsible for implementation.
Continue on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 22-AS-20260720170601
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984
VISIT DATE: 08/12/2026
NARRATIVE
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 This document was signed and dated by facility staff on July 15, 2026. LPA reviewed a physicians report stating that R1 required continuous bed care, is able to communicate their needs and is unable to bathe, dress or care for their toileting needs. R1 is marked as non ambulatory due to their physical condition. This report was signed by a medical professional on January 13, 2026. LPA reviewed an incident report for R1 stating that on July 18th, 2026, at 8:30PM R1 was complaining of severe back pain and requested to go to the hospital and staff called 911. The report states that the resident fell around 2PM but refused to be sent to the hospital. This report was signed by the facility AD on July 20th, 2026.

LPA interviewed 8 residents in care. 5 of 8 residents informed LPA that staff assist with their individual care needs. 2 of 7 residents did not confirm or deny the allegations. 1 of 8 residents informed LPA that they witnessed R1 refusing to be sent out to the hospital after falling, but was sent out by facility staff a few hours later after requesting to go via ambulance. 1 of 8 residents informed LPA that they shared a room with R1 and did not witness a fall due to not being in the room much in the afternoons and evenings.

LPA was unable to interview R1 due to not being at the facility.

LPA interviewed 5 staff and 5 of 5 staff informed LPA that R1 sustained an unwitnessed fall. 4 of 5 staff informed LPA that R1 was transported to the hospital after staff called 911. 1 of 5 staff informed LPA that when they arrived to R1s room they were already on the floor and assisted. 2 of 5 staff informed LPA that after R1 fell, they refused to go to the hospital and a few hours later requested to go due to pain. 4 of 5 staff informed LPA that R1 needs a hoyer lift when transferring and that training had been conducted on how to use one properly. 3 of 5 staff informed LPA that R1 could communicate their needs when incontinent care was needed.

LPA reviewed training conducted on how to use a hoyer lift for 4 of 5 staff with 1 of 5 staff conducting said training on April 10, 2026. LPA reviewed training conducted for 3 of 5 staff on 911 calls with topics such as unwitnessed falls and residents right on refusing to go to the hospital with 3 of 5 staff on January 16, 2026, with 1 of 5 staff conducting said training.

Based on information gathered and interviews conducted, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was left at the facility.

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/20/2026 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20260720170601

FACILITY NAME:CIELO VISTA SENIOR LIVINGFACILITY NUMBER:
306005984
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:7571 WYOMING STTELEPHONE:
(562) 569-8914
CITY:WESTMINSTERSTATE:CAZIP CODE:
92683
CAPACITY:122CENSUS: DATE:
08/12/2026
UNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Virgilio Agas "Gil" TIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide resident with a comfortable environment.
INVESTIGATION FINDINGS:
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5
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12
13
Licensing Program Analyst (LPA) Hanna Fuller made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Gil Agas and discussed the purpose of the visit.

The investigation into the facility allegation of staff did not provide resident with a comfortable environment revealed the following: It was alleged that the facility does not have air conditioning causing Resident #1 (R1) to not feel well. LPA reviewed a physicians report dated January 13, 2026, for R1 stating that they can communicate their needs and is signed by a medical professional.

LPA toured the facility and observed the facility to be at a comfortable temperature with the air conditioning operational. LPA checked the temperature in R1s room and it was tested to be at 78.6 degrees Fahrenheit.

Continue on LIC9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20260720170601
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984
VISIT DATE: 08/12/2026
NARRATIVE
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LPA interviewed 5 staff and 5 of 5 staff informed LPA that the air conditioning has always worked.

LPA interviewed 8 residents and 6 of 8 residents informed LPA that the air conditioning has always worked. 1 of 8 residents did not confirm or deny. 1 of 8 residents shares a room with R1 and stated that the air conditioning has always worked in their room and is always cool.

LPA was unable to interview R1 due to not being at the facility.

Based on the evidence gathered, the Department finds that the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4